77222 Nutrition at a GLANCE q Iraq The Costs of Malnutrition Scaling up core micronutrient nutrition • Over one-third of child deaths are due to under- nutrition, mostly from increased severity of dis- interventions in Iraq would cost less than ease.2 US$30 million per year. • Children who are undernourished between con- (See Technical Notes for more information.) ception and age two are at high risk for impaired cognitive development, which adversely affects Approximate Key Actions to Return on the country’s productivity and growth. • The Middle East and North Africa region is antic- Address Malnutrition: Investment(%):11 ipated to lose at least a cumulative US$2.3 billion Improve infant and young child 1400 to chronic disease by 2015.3 feeding through effective education • The economic costs of undernutrition and over- and counseling services. weight include direct costs such as the increased Achieve universal salt iodization. 3000 burden on the health care system, and indirect costs of lost productivity. Fortify staple foods with iron. 800 Country Context • Childhood anemia alone is associated with a Ensure an adequate supply of zinc 1370 2.5% drop in adult wages.4 supplements for the treatment of Lifetime risk of maternal death: diarrhea. 1 in 722 Where Does Iraq Stand? Examine food policies and the Not currently Under-five mortality rate: • 26% children under the age of five are stunted, 6% country regulatory system as they estimable 44 per 1,000 live births2 are underweight, and 6% are wasted.2 relate to overweight and obesity. Global ranking of stunting • One-half (48%) of those aged 15 and above are prevalence: 70th highest out of overweight or obese.5 136 countries2 Most of the irreversible damage 15% infants are born with a low birth weight.2 This is higher than the MNA average (12%) and the due to malnutrition in Iraq happens lower middle income average (7%) and is closely re- during gestation and in the first lated to Iraq’s high fertility rate and poor quality of 24 months of life.6 health care.3,4 As seen in Figure 1, when overall rates of child stunting are examined, Iraq performs better than The Double Burden of Undernutrition and Technical Notes countries in its region. However, within the coun- Overweight Stunting is low height for age. try, there is likely to be variation across geographies Iraq will not meet MDG 1c (halving 1990 rates of and socio-demographic groups. child underweight by 2015) with business as usual.6 Underweight is low weight for age. In addition, it has seen a recent increase in adult Wasting is low weight for height. Figure 1  Iraq has Relatively Lower Overall Stunting obesity.6 Low-birth weight infants and stunted chil- Rates than its Neighbors, but Large Inequities Exist dren may be at greater risk of chronic diseases such Current stunting, underweight, and wasting as diabetes and heart disease than children who estimates are based on comparison of the 70 start out well-nourished.7 Prevalence of Stunting Among most recent survey data with the WHO 60 Yemen This “double burden� is the result of various Children Under 5 (%) Child Growth Standards, released in 2006. 50 factors. Progress in improving community infra- Low birth weight is a birth weight less 40 structure and development of sound public health than 2500g. Djibouti 30 Egypt Iraq systems has been slow, thwarting efforts to reduce Overweight is a body mass index (kg/m2) 20 undernutrition; while the adoption of Western of ≥ 25; obesity is a BMI of ≥ 30. 10 diets high in refined carbohydrates, saturated fats The methodology for calculating the 0 0 500 1000 1500 2000 2500 and sugars, as well as a more sedentary lifestyle cost of scaling up core micronutrient GNI per capita (US$2008) (often arising from unemployment and security nutrition interventions can be found at: concerns) are commonly cited as the major con- www.worldbank.org/nutrition/profiles Source: Stunting rates were obtained from the WHO Global Database on Child tributors to the increase in overweight and chronic Growth and Malnutrition (figures based on WHO child growth standards). GNI data were obtained from the World Bank’s World Development Indicators. diseases.8 Solutions to Primary Causes of Undernutrition Iraq Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 31% of all newborns receive breast milk within • Undernourished children have an increased risk of • Achieving food security means ensuring quality and one hour of birth.2 falling sick and greater severity of disease. continuity of food access, in addition to quantity, for • Only 1 in 4 infants under six months are exclu- • Undernourished children who fall sick are much all household members. sively breastfed.2 more likely to die from illness than well-nourished • The PDS ration currently provides an estimated av- • During the important transition period to a mix of children. erage of 85% of caloric needs, with an equivalent breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body market value of ID 11,110 per person per month. months of age, one-half of infants are not fed ap- and can cause blood loss and anemia. This is the largest safety net in Iraq today. propriately with both breast milk and other foods.2 Solution: Prevent and treat childhood infection and Solution: Involve multiple sectors including agricul- Solution: Support women and their families to other disease. Hand-washing, deworming, zinc sup- ture, education, transport, gender, the food indus- practice optimal breastfeeding and ensure timely plements during and after diarrhea, and continued try, health and other sectors, to ensure that diverse, and adequate complementary feeding. Breast milk feeding during illness are important. nutritious diets are available and accessible to all fulfills all nutritional needs of infants up to six household members. Also, ensure that the PDS ration months of age, boosts their immunity, and reduces provides not only calories, but good nutrition as well. exposure to infections. References Vitamin and Mineral Deficiencies Cause of multiple micronutrient supplements to infants and young children, and fortification of staple 1. UNDP. 2009. Human Development Report. Hidden Hunger foods are effective strategies to improve the iron 2. UNICEF. 2009. State of the World’s Children. Although they may not be visible to the naked eye, 3. The Lancet. 2007. The Burden and Costs of status of these vulnerable subgroups. Chronic Diseases in Low-Income and Middle- vitamin and mineral deficiencies impact well-being • Zinc: 19% of the population is at risk for insuffi- Income Countries. in Iraq, as indicated in Figure 2. 4. Horton S. and Ross J. The Economics of Iron cient zinc intake.12 Zinc supplementation during Deficiency. Food Policy. 003;28:517–5. diarrheal episodes can reduce morbidity by more Figure 2  High Rates of Vitamin A and Iron Deficiency 5. WHO. 2009. WHO Global InfoBase Contribute to Lost Lives and Diminished Productivity than 40%.13 (Database). 6. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. 60 World Bank Nutrition-Related Activities in 7. Victora, CG et al. Maternal and Child Undernutrition: Consequences for Adult 50 Iraq Prevalence (%) 8. Health And Human Capital. The Lancet 2008; 40 The World Bank is currently engaging heavily with 371: 340–57.UNICEF. 2009. Programmes 30 Iraq through its analytical and advisory work. A 2006–2010: Early Childhood Care and Learning. poverty study addressing areas of food safety and 9. Popkin BM. et al. 1996. Stunting is Associated 20 with Overweight in Children of Four Nations 10 nutrition was recently completed; as were several that are Undergoing the Nutrition Transition. non-lending technical assistance knowledge fo- 0 10. WHO. 2009. Global Prevalence of Vitamin A Preschool Children Pregnant Women rums on child health, reproductive health, and Deficiency in Populations at Risk 1995–2005. Vitamin A Deficiency Anemia food security. WHO Global Database on Vitamin A Deficiency. 11. WHO. 2008. Worldwide Prevalence of Source: 1995–2005 data from the WHO Global Database on Child Growth and Anemia 1993–2005: WHO Global Database Malnutrition on Anemia. 12. Micronutrient Initiative. 2009. Investing in the Addressing undernutrition is cost • Vitamin A: 32% of preschool aged children and Future: A United Call to Action on Vitamin and pregnant women are deficient in vitamin A.9 effective: Costs of core micronutrient Mineral Deficiencies. 13. Bhandari N., et al. 2008. Effectiveness of • Iron: Current rates of anemia among preschool interventions are as low as Zinc Supplementation Plus Oral Rehydration aged children and pregnant women are 78% and US$0.05–7.92 per person annually. Salts Compared With Oral Rehydration Salts 75%, respectively.10 Iron-folic acid supplementa- Returns on investment are as high as Alone as a Treatment for Acute Diarrhea in a Primary Care Setting: A Cluster Randomized tion of pregnant women, deworming, provision 8–30 times the costs.14 Trial. Pediatrics 121;e1279–e1285. 14. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition